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Contact: Gail Donovan
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FOR IMMEDIATE RELEASE

PROFESSIONALS EXPLORE TECHNIQUES
FOR TREATING CHAOTIC, MULTI-PROBLEM FAMILIES

BROOKLYN, NY–May 17, 2001–The chaotic, multi-problem family, whose members have experienced rape, incest, domestic violence, heavy drinking, drug abuse, and depression, was explored at a recent conference sponsored by Brooklyn Psychiatric Centers.  Nearly 100 professionals from the mental health, education, and prevention sectors attended the conference, “Working with the Chaotic Multi-Problem Family,” on May 11 at Brooklyn Borough Hall.

“We organized this conference because in recent years we’ve seen an rise in the number of families with these problems in our clinics,” said Dr. Pamela D. Straker, executive director of Brooklyn Psychiatric Centers.  “More people are under stress today because they lack financial resources and they don’t have the support of a nuclear family.  In addition, drug abuse, a poor education, the movement from welfare to work, and immigration also have created increased stress for these families.”

Three panelists made presentations about the characteristics of the chaotic multi-problem family and how to treat them.  Then, staff members of Brooklyn Psychiatric Centers presented an actual case study and the panelists suggested techniques for handling it.

Gary S. Carter, CSW, director of JBFCS Co-op City Family Services, Soundview Family Services in the Bronx, said the members of the chaotic, multi-problem family:

• are in constant crisis with their children, other family members, and school, neighborhood, housing, and government systems;
• have a pervasive sense of being overwhelmed and feeling powerless;
• feel isolated and mistrustful;
• feel incompetent;
• are in abusive relationships;
• have experienced multiple traumas and abandonments that prevent self-soothing;
• turn to external ways to self-sooth such as alcohol or drugs;
• behave in unpredictable ways;
• use language for power rather than to resolve conflicts;
• have blurred boundaries between parents and children;
• offer discipline that is disorganized and erratic and is based on mood; and,
• didn’t have good role models as children and aren’t able to nurture because they haven’t been nurtured.

However, rather than seeing such as family as disorganized, Mr. Carter said he sees it as a whole with a rich history and one that has pride in it as well as shame.

Mr. Carter said the families he sees often are referred to him by the Administration for Child Services (ACS) and, as a result, they don’t trust ACS and they don’t trust him.  Nevertheless, after identifying the client’s motivation for coming to therapy, he accepts it.

“If a mom comes in and says I want ACS off my back, I’ll help get ACS off her back,” he said.  “If she says I have a 15-year-old that is a problem, I’ll start there.”

Therapists dealing with these families should expect them to be ambivalent about being in the session, he said.  “The more negative stuff about why they don’t want to be there and don’t trust the system, the better off you are,” Mr. Carter said. “Otherwise it will go underground and it will be acted out.”

Dava Weinstein, another panelist, said when working with families with many problems, it is important to ask the client to identify only one problem to work on in therapy.

“People have strengths and they will know the solutions to their problems if we help them realize it by asking the right questions,” said Ms. Weinstein, CSW, who is coordinator of Family Training, Post-masters Training Program in Advanced Clinical Social Work, Hunter College School of Social Work.

“It can be helpful to ask them what they want to work on,” Ms. Weinstein said, adding, “usually assumptions cause mistakes.”

The questions asked should be specific and related to the problem because if the client is successful working on one problem, he or she can apply the same techniques to other issues.  But the goal, for example, shouldn’t be stop doing drugs, it should be what the client wants to be doing when he or she isn’t taking drugs.

She cited a case in which a child was having difficulty settling into her new foster home and she asked the foster mother “what do you think needs to happen for this child to be at home here?”  The foster mother replied that the child talked a lot about wanting to live with her uncle, who was unable to take her.  Ms. Weinstein said it would help the child adjust if she could meet with her uncle and hear him say directly that she couldn’t live with him.

Ms. Weinstein, who also is in private practice in New York City, suggested identifying a client’s successes and building on those successes. She gave the example of a child who was failing school but who argued that he was actually doing much better than he had previously.  In fact, the child had raised his grades from the 40s to the 60s.  In this case, Ms. Weinstein suggested asking the child how he managed to increase his grades by 20 points in each class because he could use the same techniques to raise his grades even higher and pass all his classes.

She said she once asked a woman who was addicted to crack and whose children were in foster care, how she was able to stay clean long enough to visit her children.  The woman replied that she got out of bed 45 minutes before the appointment, enough time to get dressed and take the subway there, but not enough time to score.

Ms. Weinstein also suggested asking people who are depressed and suicidal how they got to their appointment that day.  She asked a woman who was emotionally abused by her husband and who had four children under the age of 5 how she was able to get her children dressed, fed and ready for the day by 9 a.m.  The woman said that when she heard her husband leave the house she put everything she was feeling in her head in a very special place and turned her energy and attention to her kids.

Ms. Weinstein also said it is helpful to ask clients to rate their situation on a scale from one to 10, with 10 being the problem is solved.  If it is a child, she suggested using five faces, beginning with a face with a frown and ending with a face with a smile and asking the child what would it take to get you to this point where the face is smiling?   In one case in which this technique was used, the child replied she would get to that point if her mother burned all the clothes and the shoes she was wearing the day she was abducted and raped.

Marjory Slobetz, the third panelist, said working with the chaotic family is difficult and stressful for the clinician.  Ms. Slobetz, CSW, BCD, director of the Child, Adolescent, Family & Couples Training Program, Postgraduate Center for Mental Health, said for this reason, it is important for supervisors to give therapists support.

Ms. Slobetz, who also maintains a private practice in Brooklyn, said relationships with individuals from these families are hard because the patient brings past experiences into every emotion.  Trauma victims have difficulty with stable empathy and that the patient projects her condition on the therapist. However, in spite of the barriers, Ms. Slobetz gave the example of a middle-aged woman who had made remarkable progress through treatment although she had experienced years of abuse as a child.

Brooklyn Psychiatric Centers, is a 94-year-old nonprofit mental health agency serving New York residents.  With its programs, Brooklyn Psychiatric Centers provides more than 54,000 visits to adults, seniors, and their families annually.  The agency is one of Brooklyn’s oldest mental health agencies and continues to be at the forefront of innovation in treatment.

More information is available from Brooklyn Psychiatric Centers at 718-875-5625.